Alert: 8 Types of Drugs That Can Affect Memory and Cognition in Older Adults
A headline such as “8 drugs that cause serious dementia” is too strong. There is no reliable list of eight medications that simply cause dementia. Some medicines can cause confusion, delirium, sedation or memory problems, and certain long-term medication exposures have been associated with increased dementia risk—but association does not prove that the medication caused dementia. The American Geriatrics Society specifically describes these as potentially inappropriate medications, not medications that are universally harmful.
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Here are eight medication groups worth discussing with a doctor or pharmacist, particularly for people over 65:
1. Anticholinergic medicines
These are among the most important to review because they can interfere with acetylcholine, a chemical involved in memory and cognition.
Examples include some older antihistamines, bladder medicines, certain antidepressants and some medicines used for nausea or dizziness.
Possible effects: dry mouth, constipation, blurred vision, confusion and memory problems.
The risk becomes more concerning when several anticholinergic medicines are taken together.
2. Benzodiazepines
Examples include medicines such as diazepam, lorazepam and alprazolam.
They can cause sedation, impaired coordination and short-term cognitive problems. Some observational research has also found associations between sustained benzodiazepine use and dementia, although the relationship is complicated by underlying conditions such as anxiety and insomnia.
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3. Sleeping pills and “Z-drugs”
Examples include zolpidem, zaleplon and eszopiclone.
These medications can cause next-day drowsiness, impaired balance and confusion, particularly in older adults. They are included among medications that require particular caution in the AGS Beers Criteria.
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4. Opioid pain medicines
Medicines such as morphine, oxycodone and hydrocodone can cause drowsiness, confusion and delirium, especially when doses are high or when combined with other sedating medicines.
That doesn’t mean someone with severe pain should stop an opioid suddenly. Pain itself needs appropriate treatment, and discontinuation should be medically supervised.
5. First-generation antihistamines
Some older antihistamines have substantial anticholinergic effects.
Examples include diphenhydramine and chlorpheniramine.
They may cause sleepiness, confusion, urinary retention and impaired thinking in older adults. The 2023 AGS Beers Criteria recommends avoiding several strongly anticholinergic medications in older people when safer alternatives are available.
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6. Certain antidepressants
Some older antidepressants—particularly tricyclic antidepressants such as amitriptyline—have significant anticholinergic effects.
They can cause confusion, constipation, urinary problems, dizziness and falls in susceptible older adults.
However, don’t stop an antidepressant on your own. Depression itself can cause significant concentration and memory difficulties, and abrupt discontinuation can cause problems.
7. Some bladder-control medications
Certain medications used for overactive bladder, particularly strongly anticholinergic drugs, can affect cognition.
If an older person develops new confusion or memory problems after starting or increasing a bladder medication, the prescribing clinician should review the treatment and consider alternatives.
8. Antipsychotic medications
Antipsychotics can cause significant adverse effects in older adults, and the Beers Criteria recommends particular caution. They can cause sedation and other cognitive and neurological effects and carry important risks in older adults with dementia.
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However, these drugs are sometimes necessary for serious psychiatric conditions. Never discontinue an antipsychotic abruptly without medical supervision.
The bigger problem: medication combinations
Sometimes the issue isn’t one particular drug. An older person may take several medications that each cause a little sedation or anticholinergic activity. Together, the overall medication burden can become substantial. The Drug Burden Index, for example, is specifically designed to quantify exposure to drugs with anticholinergic and sedative effects.
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What should you do?
If an older adult develops new memory problems, confusion, excessive sleepiness, hallucinations, dizziness or falls, ask a doctor or pharmacist to perform a complete medication review.
Bring every medication to the appointment—including prescriptions, over-the-counter medicines, sleep aids, allergy medicines and supplements.
And most importantly: don’t stop a prescription medication suddenly just because you’ve read that it may affect cognition. Some medications require gradual tapering, and the underlying illness may also need treatment.
A medication review can sometimes identify a drug, dose or combination that is contributing to cognitive symptoms—and there may be a safer alternative. The AGS published specific alternative-treatment guidance in 2025 for several medications considered potentially inappropriate for older adults.
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